In the last three articles, we looked at common triggers for hay fever (allergic rhinitis), how to avoid them and various medication choices for allergic rhinitis and their pitfalls. In this article, we will look at specific allergen immunotherapy, commonly known as allergy injections, as a choice of treatment for allergy sufferers.

Leonard Noon, a British doctor, introduced allergen immunotherapy in 1911. His student, John Freeman, popularized the idea subsequently. Now, this is practiced all over the world, and millions of adults and children have benefited from it. It is a time-tested and proven tactic for allergy sufferers!

Different from medications

Allergic diseases are caused by interaction between allergy-causing genes that you have inherited from your parents and your environment. Once developed, the allergic diseases cause allergy and asthma symptoms.

Allergy medications help relieve the symptoms only; the underlying disease remains active. Therefore, the symptoms often return soon after stopping allergy medications.

Besides, medications are expensive, cause side effects, and patients may not always be compliant with their use. This often results in patient frustration and suffering.

This is where allergy injections come in. Allergy injections, unlike medications, make the underlying disease milder, which make the symptoms better. The benefits usually outlast the injections.

In a study of grass allergic patients who received allergy injections for three to five years, 60 percent of patients still felt better three years after stopping them. This is not possible with allergy medications.

Studies prove it works

Allergen immunotherapy is suggested for treating allergic rhinitis and asthma. Many studies over the years, here and abroad, have concluded that it helps 70-90 percent of allergy sufferers. Studies have shown it helps prevent development of new allergies in children, makes the existing allergies better, and improves the quality of life, sleep and work for patients.

A study involving more than 200 children with allergic rhinitis over 10 years concluded that allergy injections might have even prevented asthma in these children.

It is common knowledge that allergy sufferers on allergen immunotherapy suffer less from complications such as sinus and ear infections. Doctors and patients agree the allergy injections reduce the cost of treatment for allergic rhinitis and asthma in the end.

How do allergy injections work?

It is not clear how allergy injections work. Your immune system has two arms: TH1 and TH2. The TH1 arm helps fight infections. The TH2 arm promotes development of allergies.

In people with allergies, the TH2 arm predominates. Allergy injections are believed to strengthen the TH1 arm and subdue the TH2 arm by re-educating your immune system. The re-educated immune system learns to ignore allergens (pollen, dander and mold) when faced.

Obviously, it takes time to do this; do not expect positive results from allergy injections for at least six to 12 months after starting them. For several reasons, pollen and animal dander immunotherapy work better than mold immunotherapy.

Are there any risks?

Allergy injections are administered as injections under the skin - initially twice weekly or once a week. Once maintenance doses are reached, the injections are spaced out - every two weeks to once a month.

For best benefits, you should receive injections for three to five years. Depending on how severe your allergies are, you may receive from one to three injections each time.

Allergy injections are not without risk. One in a hundred injections could cause life-threatening allergic reactions affecting the whole body (anaphylaxis).

Two thirds of these reactions happen in the first 30 minutes after the injections. One third could occur up to three hours after the injections.

Current recommendations demand that you wait in the doctor's office for 30 minutes after receiving the injections. If allergic symptoms appear after you leave the office, you should immediately contact your doctor by phone, call 911 and go to hospital emergency room by ambulance (not by car!).

If you have asthma, take beta-blocker medications or experienced anaphylaxis before, then you are at higher risk for later reactions and you should take suitable precautions in consultation with your doctor.

You should avoid exercise and sports for three hours after receiving allergy injections.

Natarajan Asokan, M.D., F.A.A.P. is a board-certified allergist and immunologist and a board-certified pediatrician with more than 25 years of experience as a physician and 10 years of experience as a practicing allergist and immunologist. He treats adults and children with various allergy and immunology problems. He can be reached at 1739 Beverly Ave., Suite 118, Kingman, AZ 86409, (928) 681-5800, or www.trinityallergy.com.